The population of the United Kingdom is

Size: px
Start display at page:

Download "The population of the United Kingdom is"

Transcription

1 Wound care in five English NHS Trusts: Results of a survey KEY WORDS Ageing Infection Survey Wound Wound dressing Karen Ousey Reader Advancing Clinical Practice, School of Human and Health Sciences, University of Huddersfield, Huddersfield This survey aimed to identify and quantify the demographic characteristics, treatment objectives, and wound characteristics of patients from five English NHS Trusts receiving wound treatment. Data from 4772 patients (59.8% female; 79.7% aged >65 years) were received. Approximately half were leg wounds. Most patients had one or more comorbidity, most commonly vascular and cardiovascular. The majority of wounds were <3 months duration and had no associated infection indicators (a small minority had 3 infection indicators). Swabbing was considerably more common in wounds showing no primary infection indicators than in infected wounds. Nurses were most commonly involved with dressing changes. Protecting granulation was the most common treatment objective and dressings were changed most commonly twice-weekly as a scheduled care change. No significant differences in wound or patient characteristics were observed between Trusts. John Stephenson Senior Lecturer in Biomedical Statistics, School of Human and Health Sciences, University of Huddersfield, Huddersfield Simon Barrett Lead Nurse for Tissue Viability, Humber NHS Foundation Trust, Hull Brenda King Consultant Nurse: Tissue Viability, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Nicky Morton Consultant Nurse: Tissue Viability, Lancashire Care NHS Foundation Trust, Lancashire Kim Fenwick Tissue Viability Specialist Nurse, Hertfordshire Community NHS Trust, Watford Caryn Carr Advanced Clinical Nurse Specialist, Tissue Viability, Southern Health NHS Foundation Trust, Lyndhurst The population of the United Kingdom is increasing in size and age. During the period , the number of people aged 65 years increased by 20% to 10.3 million; in 2010, 17% of the population were aged 65 years, with people aged 85 years more than doubling to 1.4 million. The percentage aged <16 years fell from 21% to 19% (Office for National Statistics [ONS], 2011). The ageing population is forecast to continue to grow over the next few decades, with projections suggesting that the number of people aged >85 years by the year 2035 will be 2.5 times larger than in 2010, accounting for 5% of the population, and that those aged years will decrease from 65% to 59% by 2035 (ONS, 2011). This is important, because if the younger population is decreasing we can assume that there may be a lack of healthcare personnel in the future to care for the increasing older population. Added to this is the ageing workforce of the health and social care sector, where a high proportion of employees are aged >45 years. In England in 2011, nurses were registered with the Nursing and Midwifery Council (NMC, 2011; The Centre for Workforce Intelligence, 2013) Around nurses on the NMC register are aged years, and are aged 55 years (Higher Education Policy Institute, 2005). The expectation is that approximately nurses will retire by 2015 (Buchan, 2005). The Centre for Workforce Intelligence (2013) projects an overall decline in the number of nurses between 2011 and 2016 because of reduced education commissions, attrition, rising retirements, net emigration of UKtrained nurses and other trends. We can assume that as the ageing population increases, there will be an increase in the need to prevent and treat challenges associated with skin integrity. However, as a large proportion of the experienced workforce in the health and social care sector is due to retire by 2015, there is a need for tissue viability practitioners to understand the current prevalence and categories of wounds, treatments and the grade of staff managing wounds, and cascade this knowledge to new practitioners, ensuring the understanding of the importance of accurate assessment and timely interventions. Everyone who undertakes wound assessment and management should be able to access appropriate education and skills to ensure competency and confidence. Cook (2011) presented results of a survey of registered and unregistered staff members perceived competency of wound bed assessment. The author concluded that most respondents believed they were competent or average, but 16% highlighted that they were unsure at times, and 9% stated they would benefit from further training. Importantly 20 Wounds UK Vol 9 No

2 all registered staff have a professional obligation to maintain their knowledge, as defined by the NMC in The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives who are clear that nurses should recognize the limits of their competence, and be accountable for keeping their knowledge and skills up-to-date (NMC, 2008). This article presents the results of a wound care survey from five English Trusts, which aimed to identify and quantify the age and gender of patients receiving wound treatment, treatment objectives, and the type, duration and characteristics of wounds. The total population for the five Trusts was people (exact figures for each Trust are not given to maintain anonymity). When interpreting the data, it was not always possible to distinguish between missing/invalid data, and questions that were correctly left blank. For example, respondents were not obliged to tick any boxes for the question relating to comorbidities, so it was not possible to distinguish between those who missed out the question and those who (correctly) left it blank because there were no comorbidities. Hence the calculated proportion refers to the proportion of the total sample who recorded one or more comorbidities. In such cases, proportions of missing data have not been calculated. Methods Ethical issues Local research governance was received from each participating Trust s research and development office. All data were anonymised and no identifying place, staff or patient names were used. Completed surveys were stored in a locked cupboard in a locked office and all electronic data stored on encrypted computers. Completed data sets have been stored on a secure server at the University of Huddersfield. Sampling Overview A total of 4772 usable responses were received. The contribution from each Trust was as follows: Trust 1: 823 (17.2% of the total sample). Trust 2: 1114 (23.3% of the total sample). Trust 3: 914 (19.2% of the total sample). Trust 4: 691 (14.5% of the total sample). Trust 5: 1230 (25.8% of the total sample). Data were recorded on paper and transferred to SPSS statistical software (version 20.0) for subsequent analyses. Proportions quoted are based on valid responses to the relevant questions in the survey (Appendix I). All percentages and proportions quoted in this study refer to valid responses. Results Patient demographics The gender balance was similar across all Trusts, with female patients outnumbering male patients in every Trust. Overall, 2154 (59.8%) of all patients were female, and 1449 (40.2%) were male. Patient ages ranged from <14 to >81 years. Ages were grouped; the exact ages of patients was not recorded. While the majority of patients from all Trusts fell into the older age groups, there were some differences in the age distribution between different Trusts; fewer elderly patients were represented in Trust 2 (about 31.4% aged 81 years) than in other Trusts, with the greatest proportion of patients in the oldest age group being found in Trust 4 (58.7%). Just under half (1964; 47.9%) of patients were aged 81 (Table 1). Table 1. Demographic characteristics of patients (n=4772). Characteristic Valid n (%) Sex 3603 Male 1449 (40.2) Female 2154 (59.8) Age group (years) 4102 <14 7 (0.2) (8.2) (11.9) (15.8) (16.0) (47.9) Comorbidities General infection 355 (7.4) Immunosupression 187 (3.9) Dermatological conditions 370 (7.8) Vascular disease 835 (17.5) Cardiovascular conditions 882 (18.5) Anaemia 204 (4.3) Malnutrition 146 (3.1) Obesity 470 (9.8) Diabetes 738 (15.5) 220 (4.6) Other 892 (18.7) 1. More than one comorbidity could be stated per patient. Percentages refer to full sample. A total of 3296 patients (69.1%) recorded one or more comorbidities. This article presents the results of a wound care survey from five English Trusts, which aimed to identify and quantify the age and gender of patients receiving wound treatment, treatment objectives, and the type, duration and characteristics of wounds. Wounds UK Vol 9 No

3 In all Trusts, nurses made decisions about treatment plans in a majority of cases. The majority of patients from all Trusts had at least one contributing/underlying disease factor. The proportion of such patients ranged from 61.1% in Trust 1 to 74.3% in Trust 5. Approximately a quarter of all patients were reported to have two or more contributing/underlying disease factors, with small numbers with three or more factors. In most Trusts, cardiovascular conditions were the most frequently reported conditions (amounting to 882 patients over all Trusts; 18.5% of all patients). However, in Trust 2, obesity was the most frequently reported condition, although over all Trusts, total numbers with this condition were lower (470 patients; 9.8% of all patients). Other commonly reported conditions included vascular conditions (835 patients; 17.5%), diabetes (738 patients; 15.5%) and dermatological conditions (370 patients; 7.8%) which were recorded in significant numbers in all Trusts (Table 1). Treatment personnel and location In all Trusts, nurses made decisions about treatment plans in a majority of cases. In most Trusts, nurses were involved in 75% or more of treatment plan decisions (Table 2). However, in Trust 2 the proportion was lower at around 58% (a significant proportion of responses from this Trust were reported as Other (i.e. not a nurse, medic/gp or case manager). In the majority of cases, the occupation of these individuals was not recorded: a range of occupations, including podiatrist, consultant, dermatologist and surgeon were recorded in low frequencies. In Table 2. Personnel involved and location of treatment plan and dressing change. Treatment plan decision personnel 4051 Nurse/district nurse 3223 (79.6) Medic/GP 142 (3.5) Other 686 (16.9) Personnel changing dressing 3954 Nurse/district nurse 3304 (83.6) Support worker 144 (3.6) Other 506 (12.8) Treatment location 3887 Patient s home / community 2987 (76.8) Community clinic 526 (13.5) Nursing home 284 (7.3) Other 90 (2.3) all Trusts, the majority (77% or more) of personnel involved with the changing of dressing were nurses or district nurses. The overall distribution of treatment locations was similar across all Trusts, with the majority of wounds treated in community clinics or in the patient s home. A minority of wounds were treated at a hospital clinic. The Trusts in which the largest proportion of patients were treated in their own homes were Trusts 4 and 5, with over 80% of wounds treated in this way in these Trusts (Table 2). Wound categories A proportion of patients were reported as having multiple wounds and these were recorded by staff on separate forms during the audit, with each wound being counted and analysed separately. The most common wounds in all Trusts except Trust 4 were venous leg ulcers, with 849 venous leg ulcers being recorded in total (20.0% of all wounds). In Trust 4, the most common wounds were traumatic wounds, which were recorded in slightly higher numbers (n=93) than venous leg ulcers (n=91) in that Trust. However it is worth noting that the majority (80.1%) of these traumatic wounds were located on the lower limb and as such may have in fact been leg ulcers if the duration had been in excess of 6 weeks. After venous leg ulcers, traumatic wounds (591; 13.9%) and surgical wounds (535; 12.6%) represented the next most common types of wounds recorded over all Trusts. No other wound type accounted for more than 8.4% of the total number of recorded wounds; however, all types of pressure ulcer considered together amounted to 767 (18.1%) of all wounds (Table 3). The European Pressure Ulcer Advisory Panel classification (2010) was used by all respondents when identifying a pressure ulcer. Substantive associations recorded between common wound types and comorbidities at Trust level were also found to exist on the combined data set. Venous leg ulcers were most strongly associated with vascular and cardiovascular conditions, with 215 patients with a venous leg ulcer (39.7%) having vascular conditions, and 117 patients with a venous leg ulcer (21.6%) having cardiovascular conditions. Mixed leg ulcers were also strongly associated with vascular conditions, with 93 mixed leg ulcer patients (46.0%) having this condition. Main reported comorbidities are summarised in Figure Wounds UK Vol 9 No

4 Across all Trusts, older patients had generally higher frequencies of wounds than younger patients. Frequency General infection Immunosuppressed Dermatological Vascular Figure 1. Main reported comorbidities. Table 3. Wound type. Wound type 4247 Pressure ulcer category (2.8) Pressure ulcer category (8.4) Pressure ulcer category (4.8) Pressure ulcer category 4 88 (2.1) Venous leg ulcer 849 (20.0) Mixed leg ulcer 275 (6.5) Diabetic foot ulcer 200 (4.7) Total leg/foot ulcers 1324 (31.2) Traumatic wound 591 (13.9) Arterial leg ulcer 151 (3.6) Fungating lesion 60 (1.4) Surgical wound 535 (12.6) Cellulitis 104 (2.4) Skin tear 243 (5.7) Burn 31 (0.7) Moisture lesion 95 (2.2) Haematoma 27 (0.6) Other 319 (7.5) Few obvious associations between gender and wound type were recorded in any of the individual Trusts or in the total sample; however, despite females outnumbering males by 3:2 in the whole sample, the majority of surgical wound patients (237; 53.3%) and diabetic foot ulcer patients (84; 55.6%) were male. Females outnumbered males in all other wound categories. Across all Trusts, older patients had generally higher frequencies of wounds than younger patients. The highest incidence of all the main categories of Cardio-vascular Anaemia Malnutrition Obesity Diabetes wounds was recorded in the >81 years age group, with the exception of surgical wounds and burns, which were approximately evenly distributed over the entire age range (<14 to >81 years). Of the main wound types, only surgical wounds and venous leg ulcers were recorded in significant numbers in patients below the age of 75. Wound characteristics Across all Trusts, the proportion of wounds located on the leg was consistently found to be about half the total number of wounds recorded. Overall, leg wounds amounted to 2350 (50.3%) of all wounds. Interestingly, some practitioners differentiated between leg, thigh, and foot/toe, and as such, there were an additional 286 (6.1%) wounds recorded as being located on the thigh, and a further 705 (15.1%) wounds recorded as being located on the foot/toe. Of all wounds 434 (9.3%) were recorded on the buttock. No other location amounted to >5.0% of reported wounds. There were no obvious differences in the proportions of wounds in various locations between Trusts (Table 4). In all Trusts, most recorded wounds were short in duration. The proportion of wounds of <6 weeks duration was lower in Trust 5 (49.7%) than in other Trusts. In all other Trusts, this category represented over half of all recorded wounds. In the entire sample, 2493 (53.5%) of all wounds were of <3 months duration, with the median wound duration between 6 weeks and 3 months (Table 5). In most Trusts, the majority of observed wounds were judged to be improving on observation, although in Trust 5 this proportion was slightly lower (49.5%). Overall the total number of wounds judged to be healing was 2563 (55.4%). However, there were no obvious differences in the improvement rates shown over the five Trusts. The proportion of wounds judged to be deteriorating was very consistent at between 8.9% and 9.7% (Table 6). In all Trusts, a very wide variety of wound lengths and widths was recorded, with most Trusts recording wounds up to about cm in length (no wounds >28 cm in length were recorded in Trust 2). Mean wound lengths and widths were very consistent, ranging from 3.14 cm (length) and 2.23 cm (width) in Trust 1 to 3.84 cm (length) and 2.65 cm (width) in Trust 4. Over the whole data set, mean wound length 24 Wounds UK Vol 9 No

5 Table 4. Wound location. Wound location 4672 Head/neck 72 (1.5) Arm/hand 197 (4.2) Groin 53 (1.1) Front torso 234 (5.0) Buttock 434 (9.3) Heel 212 (4.5) Back torso 82 (1.8) Leg 2350 (50.3) Foot/toe 705 (15.1) Other 333 (7.1) Table 5. Wound duration. Wound duration 4660 <6 weeks 1473 (31.6) 6 wks 3 mts 1020 (21.9) 3 6mts 402 (8.6) 6 mts 1 year 541 (11.6) 1 2 years 488 (10.5) 2 5 years 342 (7.3) was 3.46 cm (standard deviation [SD], 4.24 cm) and mean wound width was 2.42 cm (SD, 2.95 cm). Depth assessments were also very consistent with between 77% and 82.3% being classified as superficial in each Trust (79.6% overall; Table 6). Some differences across Trusts were noted in the proportion of wounds observed to be granulating; varying from 54.0% in Trust 2 to 38.5% in Trust 5 (45.7% overall). Most wounds across all Trusts were categorised as moist. Surrounding skin was categorised as dry or healthy/normal in a majority of cases in all Trusts, with no significant differences across Trusts in the proportions of wounds classified in this way. Practitioners across all Trusts assessed all wounds for signs of infection using appropriate indicators of wound infection. While a majority of wounds in all Trusts were classified as free from infection, the proportions varied slightly from 58.3% in Trust 1 to 68.2% in Trust 2 (overall 64.3%). The most common infection indicator was delayed healing (639; 13.4%), significantly greater in frequency than the indicators increased pain and increased exudate (Table 6). A total of 310 patients (6.5%) had three or more infection indicators. Amongst these patients, a different pattern was apparent. The most common infection indicator was increased exudate (194; 17.9%); followed by delayed healing and increased pain (Table 6). Antimicrobials were used in 151 patients with 3 or more infection indicators (48.7%). The incidence of wound swabbing varied widely between Trusts, from 2.4% in Trust 3 to 12.1% in Trust 2 (8.4% across the whole sample). Hence rates varied by a factor of 5 across Trusts, although the baseline proportion was low. Likewise, use of antibiotics varied widely. Again rates were lowest in Trust 3 (9.0%) and highest in Trust 2 (17.0%) greater by a factor of 2. The rate for the whole sample was 12.6%. In all Trusts, swabbing was considerably more common in wounds showing no primary infection indicator (Table 7). In all Trusts, the most commonly quoted treatment objective was protecting granulation, stated as a treatment objective in a majority of cases (ranging from 55.9% in Trust 5 to 66.1% in Trust 1). Quoted objectives were consistent across Trusts. In addition to protecting granulation, all five Trusts quoted protection of surrounding skin and managing exudate as key treatment objectives (Table 7) Table 6. Wound characteristics (adapted from Fletcher, 2010). 1 Wound healing status 4623 Deteriorating 424 (9.2) Static 1303 (28.2) Improving 2563 (55.4) First visit 333 (7.2) Primary wound appearance 3773 Necrotic 127 (3.4) Granulating 1707 (45.7) Overgranulating 88 (2.4) Slough 918 (24.6) Epithelialising 794 (21.3) Other 99 (2.7) Wound exudate level 4566 Dry 995 (21.8) Moist 2356 (51.6) Wet 864 (18.9) Saturated 142 (3.1) Leaking 208 (4.6) Surrounding skin condition 4278 Dry 1841 (43.4) Macerated 440 (10.4) Excoriated 255 (6.0) Inflamed 420 (9.9) Healthy/Normal 1285 (30.3) Wound infection indicators Cellulitis 228 (4.8) Increased pain 327 (6.9) Malodour 284 (6.0) Friable granulation 89 (1.9) Abscess / pus 96 (2.0) Increased exudate 361 (7.6) Delayed healing 639 (13.4) Pocketing 37 (0.8) Erythema 217 (4.5) Wound breakdown 200 (4.2) Viscous surface layer 33 (0.7) No indication of infection 2714 (56.9) Wound infection indicators in patients recording 3 indicators 3 Cellulitis 85 (7.9) Increased pain 184 (17.0) Malodour 158 (14.6) Abscess/pus 31 (2.9) Increased exudate 194 (17.9) Delayed healing 191 (17.7) Pocketing 13 (1.2) Erythema 96 (8.9) Wound breakdown 123 (11.4) Viscous surface layer 7 (0.7) Wound size 3693 (77.4) Wound length (cm) (4.24) 4 Wound width (cm) (2.95) 4 1. Unless indicated otherwise. 2. More than one infection indicator could be selected per patient. Percentages refer to full sample. A valid response to this question was recorded in 83.7% of cases. 3. Amongst 310 patients who had 3 or more infection indicators. 4. Mean (± standard deviation). 26 Wounds UK Vol 9 No

6 The incidence of the Doppler/ankle brachial pressure index (ABPI) procedure also varied widely (by a factor of 3) between Trusts from 48.4% in Trust 3 to 16.0% in Trust 5 (32.3% overall). The incidence of compression therapy varied by a factor of 2 between Trusts from 31.2% in Trust 3 to 16.1% in Trust 4 (26.6% overall). In all Trusts, the majority of patients who received either the Doppler/ABPI procedure or compression therapy also received the second procedure (728 out of 1292 patients; 56.3%). While in all Trusts the majority of dressings were changed weekly or twice-weekly, the proportions of dressings changed at this rate varied from 75.6% (Trust 5) to 62.5% (Trust 4), with an overall proportion of 70.2%. Remaining dressings were changed three or more times per week. For over half of all patients (2420; 55.0%), the primary reason for the dressing change was a routine care change, with individual proportions varying from 51.3% (Trust 5) to 60.9% (Trust 4). Dressings changed because of expected wear time being reached (1331 patients; 27.9%) and because the dressing was saturated (720 patients; 15.1%) also amounted to a significant proportion of the reported reasons in both the individual Trusts and in the whole sample. No other reason for a dressing change was quoted in more than 10% of cases (Table 8). Across all Trusts, practitioners formulated treatment plans that encompassed clear treatment objectives. These are presented in Figure 2. Summary This survey was performed across five English Trusts consisting of 4772 responses from practitioners involved in wound care activities. It was interesting to note that practitioners reported that those patients who were diagnosed as having venous leg ulcers also presented with vascular and cardiovascular conditions. This requires further investigation, as there may have been some level of misdiagnosis with ulcers being of mixed aetiology. If this is the case, there is an educational need to ensure that all practitioners are able to accurately assess and diagnose ulcer aetiologies and understand the importance of seeking guidance if there are any uncertainties regarding diagnosis. Identification and management of infected wounds was explored in the survey and highlighted that clinical decision making varied between the Table 7. Wound treatment factors. Wound swabbing 4557 Yes 384 (8.4) No 4173 (91.6) Antibiotics 4500 Yes 566 (12.6) No 3934 (87.4) Treatment objectives Protecting granulation 2804 (58.8) Debridement of necrosis 1024 (21.5) Manage bacterial burden 778 (16.3) Rehydration of wound bed 354 (7.4) 162 (3.4) Manage exudate 2052 (43.0) Protection of surrounding skin 2003 (42.0) Managing wound pain 790 (16.6) Minimise odour 388 (8.1) 1 More than one treatment objective could be selected per patient. Percentages refer to full sample. A valid response to this question was recorded in 94.9% of cases. Table 8. Dressing changes. Frequency of dressing change 4610 More than daily 119 (2.6) Daily 309 (6.7) Alternate days 358 (7.8) 3 times per week 587 (12.7) Weekly 1079 (23.4) Twice weekly 2158 (46.8) Reason for dressing change Dressing coming off 356 (7.5) Scheduled care change 2517 (52.7) Reaction to dressing 21 (0.4) Patient expectation 160 (3.4) Dressing saturated 720 (15.1) Patient removal 171 (3.6) Expected wear time 1331 (27.9) Other 131 (2.7) Note: More than one reason could be selected per patient. Percentages refer to full sample. A valid response to this question was recorded in 92.2% of cases. Trusts when deciding whether to swab a wound, use an antimicrobial dressing or administer antibiotics. In all Trusts, swabbing was considerably more common in wounds showing no primary infection indicator. This finding suggests that more In addition to protecting granulation, all five Trusts quoted protection of surrounding skin and managing exudate as key treatment objectives. Wounds UK Vol 9 No

7 Figure 2. Wound treatment objectives. Frequency Protecting granulation Debridement Manage bacterial References Buchan J (2005) Past Trends, Future Imperfect? A Review of the UK Nursing Labour Market in 2004/2005. Available at: (accessed ) Cook L (2011) Wound assessment: exploring competency and current practice. British Journal of Community Nursing Wound Care Supplement 16: S34 40 European Pressure Ulcer Advisory Panel (2010) Pressure Ulcer Prevention. Available at: (accessed ) Fletcher J (2010) Development of a new wound assessment form. Wounds UK 6(1): Higher Education Policy Institute (2005) The Education and Training of Medical and Health Professionals in Higher Education Institutions. Available at: (accessed ) Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. Available at: PhGrP2 (accessed ) Dunkley L, Haider S (2011) Nursing and Midwifery Workforce Risks and Opportunities: A Report to Review the Key Workforce Risks and Opportunities Within the Nursing and Midwifery Workforces. Centre for Workforce Intelligence, London Office for National Statistics (2011) Topic Guide to Older People. Available at: (accessed ) The Centre for Workforce Intelligence (2013) Future Nursing Workforce Projections Starting the Discussion. Available at: (accessed 19/09/13) Rehydration Manage exudate Protect surrounding skin Manage wound pain Minimise odour exploration is required as to which indictors of infection lead a practitioner to swab a wound or prescribe an antimicrobial wound dressing. The impact of the ageing population was clearly identified in the workload of practitioners managing all wound types and the promotion of skin integrity. It was noted that over 50% of patients were over the age of 81 years. This relates to the figures produced by the Office of National Statistics (2011). Examination of the data has identified that there are a wide range of wound types that require assessment and treatment, with a percentage of these wound types being complex. If, as predicted, a large proportion of the health workforce retires by 2015, managers and tissue viability specialist practitioners will need to clearly identify the educational and skills needs of the workforce. This will include highlighting competencies that clinical practitioners will need to successfully develop and achieve that encompass both registered and unregistered staff. If workforce numbers do decrease, there will be a need to investigate and explore the feasibility of teaching patients and their families/carers to manage uncomplicated wounds when discharged to their home environment, thus ensuring that the wound is managed effectively and that patients, their families and carers understand how to promote skin integrity. Wuk Declaration of Interest This article was sponsored by an unrestricted grant from Coloplast Ltd. Appendix I. Multicentre wound care survey form (based on Fletcher [2010]). Area/Locality: A MULTI CENTRE WOUND CARE SURVEY Please only complete this form if the patient has a NON healed wound 1. Patient Demographics Please tick appropriate Male Female Age Under (Waterlow 1985) Age group categories used 2. Profession a. Please state who decided treatment plan - please tick box or state other Registered Nurse Medic/GP Specialist Nurse Other: b. Please state who changed the dressing today Registered Nurse Specialist Nurse Support Worker Other: c. Please state the location of the treatment today Patients Home Community Clinic GP Surgery Nursing home Hosp OPD Hosp Ward 3. Patient co morbidities Please tick as appropriate: General Infection Anaemia Immunosuppressed Malnutrition Dermatological Conditions Obesity Vascular Disease Diabetes Cardio/Vascular Conditions Others please specify 4. How many wounds in total does the patient have? - Please tick appropriate One Two Three Four Five Six Seven Eight More Please specify *If the patient has more than one wound please complete a separate form for each wound from question 5 onwards. Please ensure you staple all forms together. 5. Wound Type Please tick one box only Pressure Ulcer What is the category/stage/grade of the pressure ulcer? 1 Non blanching erythema of intact skin 2 Partial thickness skin loss 3 Full thickness skin loss 4 Potential extensive destruction, necrosis or damage to muscle, bone. Venous leg ulcer Arterial leg ulcer Skin tear Mixed leg ulcer Fungating lesion Burn Diabetic foot ulcer Surgical wound Moisture lesion Traumatic wound Cellulitus Haematoma Other (please specify ) 6. Wound Location Please tick appropriate Head/neck Front torso Back torso Arm/hand Buttock Leg Groin Heel Foot/toe Other please specify 7. Wound Duration Please tick appropriate <2 weeks 2-6 Weeks < 6 weeks 6 weeks 3 months 3-6 months 6 months 1 year 1 2 years 2 years 5 years 5 years + 8. Wound Healing Please tick appropriate Area/Locality: Deteriorating Static Improving First visit 9. Wound Size - Please state the maximum length ( cm), maximum width ( cm) and depth (please tick) Superficial deep cavity of wound: Please state if there is any undermining present? Yes No 10. Wound bed appearance/tissue type (Please tick most prevalent tissue type) Necrotic (black brown) Slough (cream yellow) Granulating (red Epithelialising (pink) Overgranulating Other please state: 11. Wound exudate level Please tick appropriate Dry Moist Wet Saturated Leaking Please state the colour of the exudates 12. Surrounding skin condition Please tick appropriate Dry Macerated Excoriated Inflamed Healthy Other please specify 13. Wound infection Indicators Please tick appropriate Cellulitus Abscess/pus Erythema Increased pain Increased exudate Wound breakdown Malodour Delayed healing Viscous surface layer Friable granulation Pocketing at wound base No indication of infection 14. Wound swabbing - Has the wound been swabbed in the last 7 days? Yes No 15. Antibiotics - Is the patient currently taking antibiotics for wound infection? Yes No 16. Wound treatment objectives (Please tick all that apply) Protecting Granulation/Epithelialisation Manage exudate Debridement of Necrosis or Slough Protection of surrounding skin Manage Bacterial Burden Managing Wound Pain Rehydration of wound bed Minimise odour 17. Dressing selection - please list in order of application - 1 st being wound contact layer, please write clearly in CAPITALS: Please state product name and generic group eg: MEPILEX / FOAM Has advice been sought from TVN? Yes No 19. Compression therapy Has the patient had a Doppler / ABPI or other arterial investigations performed in the last 6 months: Yes No Is the patient having compression therapy? Yes No If yes please tick which is appropriate: Compression bandage Compression hosiery Reduced compression Compression other 20. Current frequency of dressing change Please tick appropriate More than daily Daily Alternate days 3 times per week Weekly Twice weekly 21. Reason for dressing change frequency Please tick appropriate Dressing coming off Patient Patient removal Scheduled care change Dressing saturated Expected wear time Reaction to dressing Other please specify 21a. Does the patient: Concord/comply with treatment? Yes No With lifestyle? Yes No Thank You for your time 28 Wounds UK Vol 9 No

Critically evaluate the organization of diabetic foot ulcer services and interdisciplinary team working

Critically evaluate the organization of diabetic foot ulcer services and interdisciplinary team working Rationale of Module Accurate nursing assessment is the key to effective diabetic foot ulcer prevention, treatment and management. A comprehensive assessment identifies ulcer aetiology and the factors which

More information

Pressure Ulcer Passport

Pressure Ulcer Passport Pressure Ulcer Passport Information for patients This is a record of the treatment you are receiving for your pressure ulcer injury. Please bring it with you to all your healthcare appointments. This will

More information

Wound Healing Community Outreach Service

Wound Healing Community Outreach Service Wound Healing Community Outreach Service Wound Management Education Plan January 2012 December 2012 Author: Michelle Gibb Nurse Practitioner Wound Management Wound Healing Community Outreach Service Institute

More information

COMPLIANCE WITH THIS DOCUMENT IS MANDATORY

COMPLIANCE WITH THIS DOCUMENT IS MANDATORY COVER SHEET NAME OF DOCUMENT Wound Wound Assessment and Management TYPE OF DOCUMENT Procedure DOCUMENT NUMBER SESLHDPR/297 DATE OF PUBLICATION April 2014 RISK RATING Medium LEVEL OF EVIDENCE N/A REVIEW

More information

Wound and Skin Assessment. Mary Carvalho RN, BSN, MBA Clinical Coordinator Johnson Creek Wound and Edema Center

Wound and Skin Assessment. Mary Carvalho RN, BSN, MBA Clinical Coordinator Johnson Creek Wound and Edema Center Wound and Skin Assessment Mary Carvalho RN, BSN, MBA Clinical Coordinator Johnson Creek Wound and Edema Center Skin The largest Organ Weighs between 6 and 8 pounds Covers over 20 square feet Thickness

More information

An evaluation of Actilite Antibacterial non-adherent dressing with Activon+

An evaluation of Actilite Antibacterial non-adherent dressing with Activon+ An evaluation of Actilite Antibacterial non-adherent dressing with Activon+ Antibacterial protection Activon honey plus Manuka oil. Non-adherent The non-adherence of the knitted viscose is further enhanced

More information

University of Huddersfield Repository

University of Huddersfield Repository University of Huddersfield Repository Atkin, Leanne and Shirlow, K. Understanding and applying compression therapy Original Citation Atkin, Leanne and Shirlow, K. (2014) Understanding and applying compression

More information

OASIS-C Integument Assessment: Not for Wimps! Part I: Pressure Ulcers

OASIS-C Integument Assessment: Not for Wimps! Part I: Pressure Ulcers OASIS-C Integument Assessment: Not for Wimps! Part I: Pressure Ulcers Presented by: Rhonda Will, RN, BS, COS-C, HCS-D Assistant Director, OASIS Competency Institute 243 King Street, Suite 246 Northampton,

More information

Topical Oxygen Wound Therapy (MEDICAID)

Topical Oxygen Wound Therapy (MEDICAID) Topical Oxygen Wound Therapy (MEDICAID) Last Review Date: September 11, 2015 Number: MG.MM.DM.15C6v2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or

More information

Position Statement: Pressure Ulcer Staging

Position Statement: Pressure Ulcer Staging Position Statement: Pressure Ulcer Staging Statement of Position The Wound, Ostomy and Continence Nurses (WOCN) Society supports the use of the National Pressure Ulcer Advisory Panel Staging System (NPUAP).

More information

Wound Care: The Basics

Wound Care: The Basics Wound Care: The Basics Suzann Williams-Rosenthal, RN, MSN, WOC, GNP Norma Branham, RN, MSN, WOC, GNP University of Virginia May, 2010 What Type of Wound is it? How long has it been there? Acute-generally

More information

Silicone pressure-reducing pads for the prevention and treatment of pressure ulcers

Silicone pressure-reducing pads for the prevention and treatment of pressure ulcers S46 Product focus Silicone pressure-reducing pads for the prevention and treatment of pressure ulcers Abstract Pressure ulcers, a key quality of care indicator, cause emotional distress to the patient,

More information

7/11/2011. Pressure Ulcers. Moisture-NOT Pressure. Wounds NOT Caused by Pressure

7/11/2011. Pressure Ulcers. Moisture-NOT Pressure. Wounds NOT Caused by Pressure Assessment and Documentation of Pressure Ulcers Jeri Ann Lundgren, RN, BSN, PHN, CWS, CWCN Pathway Health Services July 19, 2011 Training Objectives Describe etiologies of pressure ulcers Discuss how to

More information

Pressure Ulcer Grading and POVA Referral Procedure

Pressure Ulcer Grading and POVA Referral Procedure Pressure Ulcer Grading and POVA Referral Procedure Version Number: 1 Page 1/13 -Contents- Page 1. Introduction 3 2. Aim 3 3. Procedure 3 4. Responsibilities 4 5. Implementation and Training 4 6. Equality

More information

Managing cavity wounds Journal of Community Nursing March 1998 Author: Rosemary Pudner

Managing cavity wounds Journal of Community Nursing March 1998 Author: Rosemary Pudner Managing cavity wounds Journal of Community Nursing March 1998 Author: Rosemary Pudner It has been seen in recent years, that an increasing number of patients are being discharged early into the community,

More information

Pressure Ulcer Prevention Prevention Is The Cure

Pressure Ulcer Prevention Prevention Is The Cure The new name for Central Essex Community Service Pressure Ulcer Prevention Prevention Is The Cure Lorraine Grothier Clinical Nurse Specialist Tissue Viability Is Prevention Important? An estimated 4-20%

More information

Illinois Department of Public Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION. Statement of LICENSURE Violations

Illinois Department of Public Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION. Statement of LICENSURE Violations (X1) PROVER/SUPPLIER/CLIA ENTIFICATION NUMBER: (X3) SURVEY D NAME OF PROVER OR SUPPLIER (X4) SUMMARY REGULATORY OR LSC ENTIFYING INFORMATION) PROVER'S PLAN OF CORRECTION Final Observations Statement of

More information

WOCN Society Position Statement: Pressure Ulcer Staging

WOCN Society Position Statement: Pressure Ulcer Staging WOCN Society Position Statement: Pressure Ulcer Staging Originated By: Wound Committee Date Completed: 1996 Reviewed/Revised: July 2006 Revised: August 2007 Reviewed/Revised: April 2011 Definition of Pressure

More information

Monitoring surgical wounds for infection

Monitoring surgical wounds for infection Monitoring surgical wounds for infection Information for patients This leaflet explains surgical wound infection and the national programme for monitoring infections acquired in hospitals This hospital

More information

Recurrent Varicose Veins

Recurrent Varicose Veins Information for patients Recurrent Varicose Veins Sheffield Vascular Institute Northern General Hospital You have been diagnosed as having Varicose Veins that have recurred (come back). This leaflet explains

More information

Reducing the incidence of VLU by 50% in 5 years

Reducing the incidence of VLU by 50% in 5 years Wound Awareness The Challenges The Solutions Everyone Deserves Intact Skin and the Sense of Wellbeing Reducing the incidence of VLU by 50% in 5 years SIMPLY-It wont happen without General Practice General

More information

Wound Healing. Healing is a matter of time, but it is sometimes also a matter of opportunity. Hippocrates

Wound Healing. Healing is a matter of time, but it is sometimes also a matter of opportunity. Hippocrates C HAPTER 9 Wound Healing Healing is a matter of time, but it is sometimes also a matter of opportunity. Hippocrates As the above quote suggests, conduct regular and systematic wound assessments, and seize

More information

The compatibility of INTRASITE Gel and ACTICOAT : An In-Vivo and In-Vitro assessment

The compatibility of INTRASITE Gel and ACTICOAT : An In-Vivo and In-Vitro assessment *smith&nephew The compatibility of INTRASITE Gel and ACTICOAT : An In-Vivo and In-Vitro assessment 1 Trade Marks of Smith & Nephew An In-Vivo and In-Vitro assessment of the compatibility of ACTICOAT and

More information

USING ADAPTIC TOUCH Non-Adhering Silicone Dressing: CASE STUDIES

USING ADAPTIC TOUCH Non-Adhering Silicone Dressing: CASE STUDIES INTERNATIONAL CASE STUDIES USING ADAPTIC TOUCH Non-Adhering Silicone Dressing: CASE STUDIES CASE STUDIES SERIES 2013 This document has been jointly developed by Wounds International and Systagenix with

More information

CHAPTER 5 THE USE OF LEPTOSPERMUM HONEY IN CHRONIC WOUND MANAGEMENT

CHAPTER 5 THE USE OF LEPTOSPERMUM HONEY IN CHRONIC WOUND MANAGEMENT The use of Leptospermum honey in chronic wound management CHAPTER 5 THE USE OF LEPTOSPERMUM HONEY IN CHRONIC WOUND MANAGEMENT Val Robson In recent years the use of honey to manage wounds has gained considerable

More information

Use of Packing for Surgical Wounds. Maggie Benson Clinical Problem Solving II

Use of Packing for Surgical Wounds. Maggie Benson Clinical Problem Solving II Use of Packing for Surgical Wounds Maggie Benson Clinical Problem Solving II Purpose Present patient management s/p Incision and Drainage in an outpatient setting Examine evidence for the use of wound

More information

Wound Classification Name That Wound Sheridan, WY June 8 th 2013

Wound Classification Name That Wound Sheridan, WY June 8 th 2013 Initial Wound Care Consult Sheridan, WY June 8 th, 2013 History Physical Examination Detailed examination of the wound Photographs Cultures Procedures TCOM ABI Debridement Management Decisions A Detailed

More information

Introduction to Wound Management

Introduction to Wound Management EWMA Educational Development Programme Curriculum Development Project Education Module: Introduction to Wound Management Latest revision: October 2012 ABOUT THE EWMA EDUCATIONAL DEVELOPMENT PROGRAMME The

More information

Wound Management A Nurse s Guide

Wound Management A Nurse s Guide VEA Bringing Learning to Life Program Support Notes Wound Management A Nurse s Guide Health Care 20 mins Teacher Notes by Tracey MacFadyen, Registered nurse is RN. Clinical Nurse Educator Produced by VEA

More information

Report by Pat Tyrrell, Lead Nurse, Argyll & Bute CHP on behalf of Heidi May, Board Nurse Director

Report by Pat Tyrrell, Lead Nurse, Argyll & Bute CHP on behalf of Heidi May, Board Nurse Director Highland NHS Board 4 October 2011 Item 4.6(b) TISSUE VIABILITY PRESSURE ULCER PREVENTION Report by Pat Tyrrell, Lead Nurse, Argyll & Bute CHP on behalf of Heidi May, Board Nurse Director The Board is asked

More information

Suspension Order. Monday 16 March 2015. Part(s) of the register: RN2 - Registered Nurse Sub part 2 Adult August 1967

Suspension Order. Monday 16 March 2015. Part(s) of the register: RN2 - Registered Nurse Sub part 2 Adult August 1967 Suspension Order Monday 16 March 2015 Name of Registrant Nurse: NMC PIN: Mrs Geraldine Elizabeth Atando 67H1567E Part(s) of the register: RN2 - Registered Nurse Sub part 2 Adult August 1967 Substantive

More information

Graduated compression hosiery (stockings)

Graduated compression hosiery (stockings) What is compression hosiery? Compression hosiery are elasticated stockings which give support to your legs. In graduated compression hosiery, the pressure given by the stockings is greater at the ankle

More information

APPENDIX 1: INTERDISCIPLINARY APPROACH TO PREVENTION AND MANAGEMENT OF DIABETIC FOOT COMPLICATIONS

APPENDIX 1: INTERDISCIPLINARY APPROACH TO PREVENTION AND MANAGEMENT OF DIABETIC FOOT COMPLICATIONS APPENDIX 1: INTERDISCIPLINARY APPROACH TO PREVENTION AND MANAGEMENT OF DIABETIC FOOT COMPLICATIONS Template: Regional Foot Programs should develop a list of available health professionals in the following

More information

Diabetic Foot Ulcers and Pressure Ulcers. Laurie Duckett D.O. Plastic and Reconstructive Surgeon Oklahoma State University Center for Health Sciences

Diabetic Foot Ulcers and Pressure Ulcers. Laurie Duckett D.O. Plastic and Reconstructive Surgeon Oklahoma State University Center for Health Sciences Diabetic Foot Ulcers and Pressure Ulcers Laurie Duckett D.O. Plastic and Reconstructive Surgeon Oklahoma State University Center for Health Sciences Lecture Objectives Identify risk factors Initiate appropriate

More information

A NEW CLASSIFICATION OF DIABETIC FOOT COMPLICATIONS: A SIMPLE AND EFFECTIVE TEACHING TOOL

A NEW CLASSIFICATION OF DIABETIC FOOT COMPLICATIONS: A SIMPLE AND EFFECTIVE TEACHING TOOL The Journal of Diabetic Foot Complications A NEW CLASSIFICATION OF DIABETIC FOOT COMPLICATIONS: A SIMPLE AND EFFECTIVE TEACHING TOOL Authors: Dr Amit Kumar C Jain* *MBBS, D.DIAB, F.DIAB, DNB[Gen Surgery],

More information

This is my information booklet: Introduction

This is my information booklet: Introduction Hip arthroscopy is a relatively new procedure which allows the surgeon to diagnose and treat hip disorders by providing a clear view of the inside of the hip with very small incisions. This is a more complicated

More information

Summary of Recommendations

Summary of Recommendations Summary of Recommendations *LEVEL OF EVIDENCE Practice Recommendations Assessment 1.1 Conduct a history and focused physical assessment. IV 1.2 Conduct a psychosocial assessment to determine the client

More information

Management of Burns. The burns patient has the same priorities as all other trauma patients.

Management of Burns. The burns patient has the same priorities as all other trauma patients. Management of Burns The burns patient has the same priorities as all other trauma patients. Assess: - Airway - Breathing: beware of inhalation and rapid airway compromise - Circulation: fluid replacement

More information

Peninsula Commissioning Priorities Group. Commissioning Policy Varicose Vein Referral

Peninsula Commissioning Priorities Group. Commissioning Policy Varicose Vein Referral NHS Devon NHS Plymouth Torbay Care Trust Peninsula Commissioning Priorities Group Commissioning Policy Varicose Vein Referral Varicose Vein Referral Guidelines 1. Description of service/treatment Most

More information

Quality standard Published: 11 June 2015 nice.org.uk/guidance/qs89

Quality standard Published: 11 June 2015 nice.org.uk/guidance/qs89 Pressure ulcers Quality standard Published: 11 June 2015 nice.org.uk/guidance/qs89 NICE 2015. All rights reserved. Contents Introduction... 6 Why this quality standard is needed... 6 How this quality standard

More information

PROCEDURE FOR PRESSURE ULCER PREVENTION AND MANAGEMENT

PROCEDURE FOR PRESSURE ULCER PREVENTION AND MANAGEMENT Multidisciplinary PROCEDURE FOR PRESSURE ULCER PREVENTION AND MANAGEMENT Issue History July 2012 Issue Version Three Purpose of Issue/Description of Change Planned Review Date To outline evidence based

More information

Venous Leg Ulcer. Vascular services

Venous Leg Ulcer. Vascular services What is a venous leg ulcer? A venous leg ulcer is an area of broken skin on the lower leg caused by increased pressure in the veins in the leg. It can vary in colour and size and you may also have symptoms

More information

Monitoring surgical wounds for infection

Monitoring surgical wounds for infection Monitoring surgical wounds for infection Information for patients This leaflet explains surgical wound infection and the national programme for monitoring infections acquired in hospitals What are surgical

More information

Pressure Ulcers in Neonatal Patients. Rene Amaya, MD Pediatric Specialists of Houston Infectious Disease/Wound Care

Pressure Ulcers in Neonatal Patients. Rene Amaya, MD Pediatric Specialists of Houston Infectious Disease/Wound Care Pressure Ulcers in Neonatal Patients Rene Amaya, MD Pediatric Specialists of Houston Infectious Disease/Wound Care Objectives Review skin anatomy and understand why neonatal skin is at increased risk for

More information

Pressure Ulcers Risk Management and Treatment

Pressure Ulcers Risk Management and Treatment Pressure Ulcers Risk Management and Treatment Objectives State reasons why individuals initiate lawsuits. Define strategies to reduce the risk of litigation. Determine appropriate treatment for the patient.

More information

APPLICATION OF DRY DRESSING

APPLICATION OF DRY DRESSING G-100 APPLICATION OF DRY DRESSING PURPOSE To aid in the management of a wound with minimal drainage. To protect the wound from injury, prevent introduction of bacteria, reduce discomfort, and assist with

More information

Moisture lesions. Sara-jane Kray Clinical Nurse Specialist (Honorary contract KCHT)

Moisture lesions. Sara-jane Kray Clinical Nurse Specialist (Honorary contract KCHT) Moisture lesions Sara-jane Kray Clinical Nurse Specialist (Honorary contract KCHT) Aim To differentiate between moisture lesions and pressure ulcers. To understand the effects of urine and faeces on skin

More information

After care following insertion of a suprapubic catheter

After care following insertion of a suprapubic catheter Other formats After care following insertion of a suprapubic catheter If you need this information in another format such as audio tape or computer disk, Braille, large print, high contrast, British Sign

More information

Open and Honest Care in your Local Hospital

Open and Honest Care in your Local Hospital Open and Honest Care in your Local Hospital The Open and Honest Care: Driving Improvement Programme aims to support organisations to become more transparent and consistent in publishing safety, experience

More information

Case Series: The use of AQUACEL Ag Extra dressing on Chronic and Acute Wounds

Case Series: The use of AQUACEL Ag Extra dressing on Chronic and Acute Wounds Case Series: The use of AQUACEL Ag Extra dressing on Chronic and Acute Wounds Executive Summary ConvaTec, the company that brings you the anti-microbial dressing, AQUACEL Ag, has taken its Hydrofibe r

More information

Cellulitis. Patient information Leaflet. Leaflet no: GMed 005 Version 1.2

Cellulitis. Patient information Leaflet. Leaflet no: GMed 005 Version 1.2 Cellulitis Patient information Leaflet Leaflet no: GMed 005 Version 1.2 October 2013 What is Cellulitis? Cellulitis is a bacterial infection of the deep layer of skin (dermis) and the layer of fat and

More information

Information for patients. Lymphoedema. Sheffield Vascular Institute. Northern General Hospital

Information for patients. Lymphoedema. Sheffield Vascular Institute. Northern General Hospital Information for patients Lymphoedema Sheffield Vascular Institute Northern General Hospital You have been diagnosed as having Lymphoedema. This leaflet explains more about Lymphoedema and answers some

More information

Beverlin Allen, PhD, RN, MSN, ARNP

Beverlin Allen, PhD, RN, MSN, ARNP Pressure Ulcers & Nutritional Deficits in Elderly Long-Term Care Patients: Effects of a Comprehensive Nutritional Protocol on Pressure Ulcer Healing, Length of Hospital Stay & Health Care Charges Beverlin

More information

Wounds UK. Exsudex : another means of managing exudate Pauline Beldon

Wounds UK. Exsudex : another means of managing exudate Pauline Beldon Wounds UK Exsudex : another means of managing exudate Pauline Beldon Product REVIEW Exsudex : another means of managing exudate Heavily exuding wounds can cause discomfort to the patient as well as inhibiting

More information

WOUND MANAGEMENT PROTOCOLS WOUND CLEANSING: REMOVING WOUND DEBRIS FROM WOUND BASE

WOUND MANAGEMENT PROTOCOLS WOUND CLEANSING: REMOVING WOUND DEBRIS FROM WOUND BASE WOUND MANAGEMENT PROTOCOLS PURPOSE: Provide nursing personnel with simple guidance regarding appropriate dressing selection in the absence of wound specialist expertise Identify appropriate interventions

More information

Pressure ulcers. Information for patients and carers. Prevention and treatment

Pressure ulcers. Information for patients and carers. Prevention and treatment Pressure ulcers Information for patients and carers Prevention and treatment What is a pressure ulcer? A pressure ulcer is damage that occurs to the skin and underlying tissue that may become an open wound.

More information

Information for patients who require Foam Sclerotherapy for Varicose Veins.

Information for patients who require Foam Sclerotherapy for Varicose Veins. Information for patients who require Foam Sclerotherapy for Varicose Veins. Why do I need this procedure? Everybody has two sets of veins in the legs. These include the superficial and deep veins. Their

More information

Professor Angela Tod Elizabeth Dinsdale, Catherine Homer, Dr Simon Palfreyman

Professor Angela Tod Elizabeth Dinsdale, Catherine Homer, Dr Simon Palfreyman Professor Angela Tod Elizabeth Dinsdale, Catherine Homer, Dr Simon Palfreyman Obesity has been identified amongst other factors as a cause of lower limb ulceration due to its contribution to venous hypertension

More information

Skin Care In Bladder And Bowel Dysfunction Wendy Ness Colorectal Nurse Specialist

Skin Care In Bladder And Bowel Dysfunction Wendy Ness Colorectal Nurse Specialist Skin Care In Bladder And Bowel Dysfunction Wendy Ness Colorectal Nurse Specialist Function Of The Skin Healthy skin serves several purposes it protects the internal organs physically, chemically and biologically

More information

NPUAP PRESSURE ULCER ROOT CAUSE ANALYSIS (RCA) TEMPLATE National Pressure Ulcer Advisory Panel March 2014

NPUAP PRESSURE ULCER ROOT CAUSE ANALYSIS (RCA) TEMPLATE National Pressure Ulcer Advisory Panel March 2014 Purpose: The development of a facility acquired pressure ulcer brings with it both a financial impact to an institution and a performance or quality of care impact that may be reportable to state or government

More information

V03 Varicose Veins Surgery

V03 Varicose Veins Surgery V03 Varicose Veins Surgery What are varicose veins? Varicose veins are enlarged and twisted veins in the leg. They are common and affect up to 3 in 10 people. More women than men ask for treatment, with

More information

NPUAP PRESSURE ULCER ROOT CAUSE ANALYSIS (RCA) TEMPLATE

NPUAP PRESSURE ULCER ROOT CAUSE ANALYSIS (RCA) TEMPLATE Purpose: The development of a facility acquired pressure ulcer brings with it both a financial impact to an institution and a performance or quality of care impact that may be reportable to state or government

More information

National Diabetes Inpatient Audit

National Diabetes Inpatient Audit National Diabetes Inpatient Audit 2013 We are the trusted source of authoritative data and information relating to health and care. www.hscic.gov.uk enquiries@hscic.gov.uk Prepared in collaboration with:

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. Safe staffing for nursing in adult inpatient wards in acute hospitals overview bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed

More information

OPERATION:... Proximal tibial osteotomy Distal femoral osteotomy

OPERATION:... Proximal tibial osteotomy Distal femoral osteotomy AFFIX PATIENT DETAIL STICKER HERE Forename.. Surname NHS Organisation. Responsible surgeon. Job Title Hospital Number... D.O.B.././ No special requirements OPERATION:..... Proximal tibial osteotomy Distal

More information

What dressing for what wound. Prudence Lennox National Clinical Leader Healthcare Rehabilitation Ltd

What dressing for what wound. Prudence Lennox National Clinical Leader Healthcare Rehabilitation Ltd What dressing for what wound Prudence Lennox National Clinical Leader Healthcare Rehabilitation Ltd Wound assessment Accurate wound assessment is a prerequisite to planning appropriate care & should adopt

More information

Pressure Ulcers: Facility Assessment Checklists

Pressure Ulcers: Facility Assessment Checklists Pressure Ulcers: Facility Assessment Checklists This is a series of self-assessment checklists for nursing home staff to use to assess processes related to managing pressure ulcers in the facility, in

More information

Algidex Ag. wet - moist - dry wound

Algidex Ag.  wet - moist - dry wound Algidex Ag wet - moist - dry wound Algidex Ag is a unique combination of silver, alginate and maltodextrin. It provides immediate and sustained antimicrobial action against a broad spectrum of wound pathogens

More information

Best Practice Guidelines BPG 1 Pressure Ulcer Prevention & Management

Best Practice Guidelines BPG 1 Pressure Ulcer Prevention & Management Best Practice Guidelines BPG 1 Pressure Ulcer Prevention & Management DOCUMENT STATUS: Approved DATE ISSUED: 14.4.15 DATE TO BE REVIEWED: 13.10.17 AMENDMENT HISTORY VERSION DATE AMENDMENT HISTORY V 1 9.9.13

More information

NURSING DOCUMENTATION

NURSING DOCUMENTATION NURSING DOCUMENTATION OBJECTIVES 1. The learner will be able to state 2 components of documentation that meet the 2. The learner will be able to identify 4 characteristics of a complete skin assessment

More information

Working patterns and levels of underemployment among Associate Dentists

Working patterns and levels of underemployment among Associate Dentists BDA RESEARCH FINDINGS 3 December 2013 Working patterns and levels of underemployment among Associate Dentists Key Findings Associates work an average of 31.49 hours per week Administration accounts for

More information

Seton Medical Center Hepatocellular Carcinoma Patterns of Care Study Rate of Treatment with Chemoembolization 2007 2012 N = 50

Seton Medical Center Hepatocellular Carcinoma Patterns of Care Study Rate of Treatment with Chemoembolization 2007 2012 N = 50 General Data Seton Medical Center Hepatocellular Carcinoma Patterns of Care Study Rate of Treatment with Chemoembolization 2007 2012 N = 50 The vast majority of the patients in this study were diagnosed

More information

Lambeth and Southwark Action on Malnutrition Project (LAMP) Dr Liz Weekes Project Lead Guy s & St Thomas NHS Foundation Trust

Lambeth and Southwark Action on Malnutrition Project (LAMP) Dr Liz Weekes Project Lead Guy s & St Thomas NHS Foundation Trust Lambeth and Southwark Action on Malnutrition Project (LAMP) Dr Liz Weekes Project Lead Guy s & St Thomas NHS Foundation Trust Page 0 What is the problem? Page 1 3 million (5 % population) at risk of malnutrition

More information

Facts About Peripheral Arterial Disease (P.A.D.)

Facts About Peripheral Arterial Disease (P.A.D.) Facts About Peripheral Arterial Disease (P.A.D.) One in every 20 Americans over the age of 50 has P.A.D., a condition that raises the risk for heart attack and stroke. Peripheral arterial disease, or P.A.D.,

More information

Pressure Injury Prevention and Management Policy

Pressure Injury Prevention and Management Policy Pressure Injury Prevention and Management Policy Owner (initiating the document): Dr Amanda Ling Contact name and number: Rachel Dennis (Ph: 9222 2197) Version: 1.5 Approved by: Professor Bryant Stokes,

More information

Negative Pressure Wound Therapy (VAC Therapy) Guidelines

Negative Pressure Wound Therapy (VAC Therapy) Guidelines Negative Pressure Wound Therapy (VAC Therapy) Guidelines This is a living document and will be updated as required March 2013 Negative Pressure Wound Therapy Negative Pressure Wound Therapy (NPWT), also

More information

CHAPTER V DISCUSSION. normal life provided they keep their diabetes under control. Life style modifications

CHAPTER V DISCUSSION. normal life provided they keep their diabetes under control. Life style modifications CHAPTER V DISCUSSION Background Diabetes mellitus is a chronic condition but people with diabetes can lead a normal life provided they keep their diabetes under control. Life style modifications (LSM)

More information

Endovenous Laser Therapy

Endovenous Laser Therapy Information for patients Endovenous Laser Therapy Northern General Hospital You have been given this leaflet because you will be having Endovenous Laser Therapy (EVLT). This leaflet explains more about

More information

The true cost of wounds. And how to reduce it

The true cost of wounds. And how to reduce it The true cost of wounds And how to reduce it Wounds are a growing challenge Wounds have been called the silent epidemic. In a typical hospital setting today, between 25% and 40% of beds will be occupied

More information

Patient survey report 2008. Category C Ambulance Service User Survey 2008 North East Ambulance Service NHS Trust

Patient survey report 2008. Category C Ambulance Service User Survey 2008 North East Ambulance Service NHS Trust Patient survey report 2008 Category C Ambulance Service User Survey 2008 The national Category C Ambulance Service User Survey 2008 was designed, developed and co-ordinated by the Acute Surveys Co-ordination

More information

Pressure Ulcers Assessing and Staging. Anne Pirzadeh RN CWOCN University of Colorado Hospital June 2010

Pressure Ulcers Assessing and Staging. Anne Pirzadeh RN CWOCN University of Colorado Hospital June 2010 Pressure Ulcers Assessing and Staging Anne Pirzadeh RN CWOCN University of Colorado Hospital June 2010 Never Events: Pressure Ulcers Pressure Ulcer Codes: MD documentation of pressure ulcers determines

More information

Diabetes Foot Screening and Risk Stratification Tool

Diabetes Foot Screening and Risk Stratification Tool Diabetes Foot Screening and Risk Stratification Tool Welcome to the Diabetes Foot Screening and Risk Stratification Tool This tool is based on the work of the Scottish Foot Action Group (SFAG). It has

More information

PRESCRIBING OF NHS MEDICATION RECOMMENDED DURING OR AFTER A PRIVATE EPISODE OF CARE

PRESCRIBING OF NHS MEDICATION RECOMMENDED DURING OR AFTER A PRIVATE EPISODE OF CARE East Surrey CCG Guildford & Waverley CCG North West Surrey CCG Surrey Downs CCG Surrey Heath CCG PRESCRIBING OF NHS MEDICATION RECOMMENDED DURING OR AFTER A PRIVATE EPISODE OF CARE Version: 2.2 Name of

More information

PERFORMANCE MEASURE TECHNICAL SPECIFICATIONS

PERFORMANCE MEASURE TECHNICAL SPECIFICATIONS PERFORMANCE MEASURE TECHNICAL SPECIFICATIONS 1. Rate of Emergency Department Visits The number of visits experienced by PACE participants to acute care hospital Emergency Departments, urgent care clinics,

More information

FUNCTIONS OF THE SKIN

FUNCTIONS OF THE SKIN FUNCTIONS OF THE SKIN Skin is the largest organ of the body. The average adult has 18 square feet of skin which account for 16% of the total body weight. Skin acts as a physical barrier for you to the

More information

Transition to Community Nursing Practice

Transition to Community Nursing Practice Transition to Community Nursing Practice Contents Section A - Thinking about working in the community Chapter 1 - What is community nursing Chapter 2 - Making the transition Section B - Working in the

More information

Social work education in England 2009-2014

Social work education in England 2009-2014 Social work education in England 2009-2014 A report for the Department of Health (DH) March 2015 Produced by Skills for Care for the Department of Health Contents Introduction 3 1. Enrolments 4 Interim

More information

Pressure Ulcers Among Nursing Home Residents: United States, 2004

Pressure Ulcers Among Nursing Home Residents: United States, 2004 Pressure Ulcers Among Nursing Home Residents: United States, 2004 Eunice Park-Lee, Ph.D., and Christine Caffrey, Ph.D., Division of Health Care Statistics Key findings Data from the National Nursing Home

More information

A Pocket Guide. Application and Cutting Guide

A Pocket Guide. Application and Cutting Guide A Pocket Guide Application and Cutting Guide Developed by Pia Carlsen, RN, Denmark Jacqui Fletcher, Principal Lecturer, MSc BSc (Hons) PG Dip (ED) RN ILT, UK Maria Mousley, AHP, Consultant Podiatrist,

More information

Review of diabetes care in London Health and Environment Committee

Review of diabetes care in London Health and Environment Committee The London Assembly s Health and Environment Committee intends to review diabetes care in London. Aim of review The purpose of this review is for the Committee to understand the extent of diabetes prevalence

More information

VARICOSE VEINS. Information Leaflet. Your Health. Our Priority. VTE Ambulatory Clinic Stepping Hill Hospital

VARICOSE VEINS. Information Leaflet. Your Health. Our Priority. VTE Ambulatory Clinic Stepping Hill Hospital VARICOSE VEINS Information Leaflet Your Health. Our Priority. Page 2 of 7 Varicose Veins There are no accurate figures for the number of people with varicose veins. Some studies suggest that 3 in 100 people

More information

healthcare associated infection 1.2

healthcare associated infection 1.2 healthcare associated infection A C T I O N G U I D E 1.2 AUSTRALIAN SAFETY AND QUALITY GOALS FOR HEALTH CARE What are the goals? The Australian Safety and Quality Goals for Health Care set out some important

More information

Diabetes: Factsheet. Tower Hamlets Joint Strategic Needs Assessment 2010-2011. Executive Summary. Recommendations

Diabetes: Factsheet. Tower Hamlets Joint Strategic Needs Assessment 2010-2011. Executive Summary. Recommendations Diabetes: Factsheet Tower Hamlets Joint Strategic Needs Assessment 2010-2011 Executive Summary Diabetes is a long term condition that affects 11,859 people in Tower Hamlets, as a result of high levels

More information

Pressure Ulcers in the ICU Incidence, Risk Factors & Prevention

Pressure Ulcers in the ICU Incidence, Risk Factors & Prevention Congress of the Critical Care Society of South Africa Sun City, 10-12 July 2015 Pressure Ulcers in the ICU Incidence, Risk Factors & Prevention Stijn BLOT Dept. of Internal Medicine Faculty of Medicine

More information

ARTHRITIS INTRODUCTION

ARTHRITIS INTRODUCTION ARTHRITIS INTRODUCTION Arthritis is the most common disease affecting the joints. There are various forms of arthritis but the two that are the most common are osteoarthritis (OA), and rheumatoid arthritis

More information

Wound, Ostomy and Continence Nurses Society s Guidance on OASIS-C1 Integumentary Items: Best Practice for Clinicians

Wound, Ostomy and Continence Nurses Society s Guidance on OASIS-C1 Integumentary Items: Best Practice for Clinicians Wound, Ostomy and Continence Nurses Society s Guidance on OASIS-C1 Integumentary Items: Best Practice for Clinicians Acknowledgments Wound, Ostomy and Continence Nurses Society s Guidance on OASIS-C1 Integumentary

More information

2. Incidence, prevalence and duration of breastfeeding

2. Incidence, prevalence and duration of breastfeeding 2. Incidence, prevalence and duration of breastfeeding Key Findings Mothers in the UK are breastfeeding their babies for longer with one in three mothers still breastfeeding at six months in 2010 compared

More information

Protection and treatment of pressure ulcers. A Coloplast Wound Care quick guide

Protection and treatment of pressure ulcers. A Coloplast Wound Care quick guide Protection and treatment of pressure ulcers A Coloplast Wound Care quick guide Table of content Foreword... 3 Introduction to pressure ulcers... 4 Good clinical practice... 5 Pressure ulcer guide... 6

More information

REHABILITATION FOLLOWING A LOWER LIMB AMPUTATION

REHABILITATION FOLLOWING A LOWER LIMB AMPUTATION REHABILITATION FOLLOWING A LOWER LIMB AMPUTATION This booklet gives you information about the rehabilitation process following your amputation. The information is a guide as everyone will progress differently

More information

Previous history of ulcers on feet which were alleviated by introduction of Propet stretch shoes

Previous history of ulcers on feet which were alleviated by introduction of Propet stretch shoes EDP- A case study for Vasyli medical trialling diabetic insole and Dr Comfort footwear BY SALLY LAXTON BAppSci(Pod) PODIATRIST- Knox Community Health Service EDP is a 68 year old female solid build Medical

More information